We conducted a retrospective study of the placement of porous-coated acetabular components using screws at more than 20 mm above the teardrop without structural bone graft for dysplastic hips to determine long-term outcome. Thirty hips (29 patients) were monitored for a mean of 15.2 years (range, 10.4-18.3 years) after surgery. Compared with 12 contralateral normal hips, the distance of the hip center from the teardrop was significantly high (26.8 +/- 4.8 and 13.4 +/- 2.7 mm P < .001); however, it was not laterally different (31. 5 +/- 5.1 and 31.7 +/- 5.0 mm). No acetabular components showed loosening. One metal shell was revised for wear and osteolysis. Morselized bone grafted in 25 hips was incorporated in all cases. Slight elevation of the hip center without lateralization in cementless cups fixed with screws was well tolerated for dysplastic hips.